Severe Constipation – Extreme Pain, Complications

Complications of Severe Constipation

Severe constipation, acute or chronic, has to be treated promptly, otherwise complications mentioned below, may develop.

1. Bloating

Bloating and severe pain, usually in the lower left abdomen may result from gas, produced by normal intestinal bacteria that break down fiber in the stool stuck in the colon. The left side of the abdomen is distended and usually tender to touch.

2. Lazy Colon

Lazy colon does not respond to presence of the stool in the colon and gastro-colic reflex that normally stimulate the bowel movement after food enters the stomach. Often even laxatives do not help. This poor colon activity may result from long term laxatives abuse, postponing bowel movements or prolonged bed rest. You often do not feel the urge to have a bowel movement. Lazy colon is a synonym for severe chronic constipation and does not mean a permanent colon impairment. You can achieve relief only by eliminating all possible causes of constipation and sticking with appropriate diet and active life style.

3. Fecal Impaction

In fecal impaction, a solid stool sticks in your colon and you can not expel it by your natural effort. It typically occurs in old bedridden patients, but can also affect other adults or children with chronic constipation or those taking opiates or methadone. A meal with a large amount of cereals without drinking enough fluid may also result in fecal impaction. In infants, rice cereals with milk could be the cause. Sensation of fullness or pain in the rectum, urge to defecate, abdominal discomfort, cramping, nausea and frequent urge to urinate are main symptoms. Clear stool may accidentally pass impacted stool; this is called paradoxical diarrhea. You may feel a hard lump when you press deeply upon the lower left part of your abdomen.

Sometimes you can remove the stool piece by piece using a finger, or a doctor can do so under local or general anesthesia. Forceful expelling hard stool is not recommended since your anus can tear. Water irrigation using a sigmoidoscope is sometimes necessary. Glycerin suppositories or phosphate or arachis oil enema may also be used. Stool softener, as docusate, may help pass the stool. If impaction is higher in the colon, an oral solution containing polyethylene glycol (as used in colonoscopypreparation) can be used carefully under doctor control. Rarely, operative removal of impacted stool is required.  Fiber laxatives, like metamucil, may be used as prevention of impaction (1). Read about foods that cause constipation.

4. Obstipation

Obstipation is severe constipation caused by intestinal obstruction, which may be acute or chronic, partial or complete. Constipation, abdominal distension, painful cramps and vomiting are main symptoms. Obstruction of the intestine may be caused by a polyp, cancer, scar tissue (adhesionsor strictures) developed after surgery or inflammation, volvulus (intestine twist upon itself – congenital defect found in infants), intussusception (telescoping, when one part of intestine slips into adjacent part; found in infants and young children), hernia, gallstones or foreign bodies. Certain diseases, like scleroderma, lupus or amyloidosis, can affect motility of the colonic wall. Ultrasound can detect excessive stool within the intestine. Obstipation has to be solved quickly by operation to prevent bowel perforation, bleeding or infection.

5. Rectal Prolapse

Rectal prolapse is protrusion of a part of the rectum through the anal opening during the bowel movement. It usually occurs in old people with chronic constipation who have week pelvic floor muscles and strain during the bowel movement. Full-thickness rectal prolapse usually causes constipation, while partial prolapse involving only the rectal lining does not.

Bulking laxatives or stool softeners may prevent aggravation of prolapse, but sometimes a surgery is necessary.

6. Rectocele

A rectocele, mostly occuring in women after menopause, means bulging of the rectum forward toward the vagina. It happens after heavy vaginal delivery or constant lifting of heavy loads. The stool may be trapped in the bulge. A doctor can detect this bulge during a vaginal and rectal examination.

Kegel exercises to strengthen muscles of pelvic floor may help in mild cases (2). If a rectocele protrudes through the vagina, surgery is usually necessary.

7. Anal Fissure

An anal fissure is a tear of the anal mucosa occuring during forced passage of large and hard stool. After the tear, you may feel severe pain lasting for several hours, and you may find blood on the stool or toilet tissue. Pain and bleeding during the bowel movements may persist for several weeks.

Treatment:

  • Warm sitz baths for 10-20 minutes few times a day sooth anal muscles
  • Stool softeners enable soft passage of the stool
  • Local analgesic creams relieve the pain
  • A tear usually heals completely in few weeks on its own, but sometimes surgical treatment is required.

Repeated injury of the anal sphincter by hard defecation may lead to patulous (widened, spreading) anus with diminished anal sphincter tone; a surgical repair is required in this case.

8. Chronic Hemorrhoids

Chronic hemorrhoids are common complication of chronic constipation. Treatment includes diet rich in fiber and fluid, physical activity, sitz baths, anti-hemorrhoidal and analgesic creams. Bluish hardened hemorrhoids with extreme anal pain and tenderness may result from thrombosed hemorrhoids, in which a blood clot form in the anal veins; an urgent surgical removal of a clot is required.

9. Non-Intestinal Complications

Urinary incontinence or infection or incomplete urine excretion are often connected with constipation where the rectum is full of hard stool.

Heavy straining may trigger heart attack or stroke. Holding breath and exerting raises the pressure in the chest cavity, preventing the blood from the veins to enter the heart. When the breath is released, the pressure within the chest drops and the blood having being trapped within the veins is quickly propelled through the heart, resulting in increased heart rate and blood pressure. Shortly thereafter, the heart rate reflexively slows down, what may trigger a heart attack in vulnerable persons. By the same mechanism, suddenly increased and then decreased blood flow in the brain may result in stroke or transient ischemic attack (TIA). Additionally, a blood clot may be dislodged from atherosclerotic brain arteries resulting in stroke. These are two causes of not so rare “toilet deaths” mostly occurring in old people with severe atherosclerosis. Squatting position during the bowel movement greatly reduces a need for straining.

References:

  1. Fecal impaction  (nlm.nih.gov)
  2. Kegel exercises  (mayoclinic.com)
About Jan Modric (249 Articles)
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  • Annabelle Wattenscheid

    I poop maybe 5-8 times a week. If I’m lucky I poop once a day. But this past week I don’t remember pooping at all. I am on my period. And pooping seems impossible. I have been in a lot of pain for the past 10 hours. But nothing is happening. I don’t want to go to the hospital because they will just pump me with drugs and send me home. I have gone to the hospital in the past and that’s all they have done for me. I need to find a way to stop my constipation because I can’t live like this. I missed ten days if school just this school year because if this. I just don’t know what to do anymore.

  • asma

    Hi there,
    my daughter is 4 years old now and she has constipation problem when she was 1.5,i use to gave her brown sugar with orange juice and she loves to eat all kinds of fruits bt still it wont help!
    When her constipation started she was on formula milk and we changed lots of milk and add fruits to her diet and started using brown bread and it helped for some time but she is very sensitive now if i wont gave her any fruit for 2 or 3 days she has her constipation back! nutelle,cheese,cold milk,choc all makes her constipated bt previously she was able to do poop once daily if she has a well maintained balanced diet although she ate all these foods bt little bit bt now she do poop once in two days and more sensitive to these foods…last year she had stomach aches for 1 week nd then we went on vacation and on the very first day she starts vomitting and we have to rush to the emergency nd they said its viral nd gave some kind of injection nd she was ok then..after that she had stomach pain after some months gap nd usually in the centre of belly just around naval button nd doc said its coz of worms nd gives vermox bt now for the past 1 month she has the same pain which is now worst nd she is on moxal nd yesterday she accidently passed urine nd wid dat she passed poop also on the floor(she never did that before)…bcoz of constipation nd stomach aches m so worried now plz tell me what should i do?her stomach pain usualy started after she ate something PLZ HELP SHE IS MY ONLY CHILD ND M SO WORRIED ABOUT HER!

  • Amy

    My bowels only move about 3 times a month. I have to use enemas usually to start them so I’m not in sever pain.I get sick to stomach and can vomit foods that were ate at least 3 day before. Help I’m miserable

  • Stephanie Bishop

    I have been on laxatives since I was little…..seriously I don’t know what to do anymore fiber makes things worse! And I’ve heard “drink more water” if I drank anymore water I’d be sick from it! I can’t drink milk because it makes things worse and doctor gave me Linzess and told me to keep things moving I lost 20 pounds of feces!!! 20 POUNDS!!!! So I’m stuck with Milk of magnesium, Miralax and magnesium citrate every afternoon and in the morning I take the Linzess with 2 glasses of water….by afternoon my poop is very sticky and incredibly messy it’s very hard to pass. I’m absolutely miserable.